Provider Demographics
NPI:1093780686
Name:VITKO, LORI L (ARNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:VITKO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6582 165TH ST
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-8793
Mailing Address - Country:US
Mailing Address - Phone:641-932-7172
Mailing Address - Fax:641-932-7174
Practice Address - Street 1:6582 165TH ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-8793
Practice Address - Country:US
Practice Address - Phone:641-932-7172
Practice Address - Fax:641-932-7174
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-076420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0234799Medicaid
IA0234799Medicaid
IAS88385Medicare UPIN